GOOD MORNING, EVERYBODY.
WELCOME TO THE BNP. HEARING. FOR
JANUARY. 9TH WE HAVE ONE BILL ON
THE AGENDA. UM. ANYBODY WANNA
PRESENT IT? YOUR HANDS. NO
TAKERS. UM. IF MR LOWE IS IN THE
BUILDING, IT LOOKS LIKE HE'S IN
THE BUILDING. SO I I'M CONFIDENT
HE WILL BE ON HIS WAY SOON. WHEN
HE GETS HERE, WE'LL GET STARTED.
I GUESS. IN THE MEANTIME, I
COULD START WITH SOME OPENING
REMARKS. WELCOME TO THIS
MORNING'S BMP COMMITTEE HEARING,
WHICH IS OUR FIRST REGULARLY
SCHEDULED HEARING FOR THE YEAR
WILL BE CONSIDERING JUST ONE
BILL TODAY THAT IS SUBJECT TO
THE TWO YEAR BILL DEADLINE. I
WOULD LIKE TO WELCOME THE NEW
MEMBERS OF THE COMMITTEE AND
THANK THEM IN ADVANCE FOR THEIR
PROMPT AND RELIABLE ATTENDANCE,
AT LEAST SOME OF THEM THIS
MORNING. UH AND THROUGHOUT THE
COMING YEAR IN PARTICULAR, I
WANT TO WELCOME THE NEW MEMBERS.
ASSEMBLYMEMBER'S CARILLO LOW
PELLERIN, SANCHEZ, SORIA AND
ZABAR TO THE COMMITTEE AND
WELCOME TO ALL THE RETURNING
MEMBERS AS WELL FOR TODAY'S
HEARING WILL BE ALLOWING PRIMARY
WITNESSES HERE IN THE ROOM TODAY
TO SPEAK FOR UP TO TWO MINUTES
EACH WITHOUT THE TWO PRIMARY
WITNESSES PER SIDE. ANY
ADDITIONAL WITNESSES WILL BE
LIMITED TO NAME POSITION ON THE
BILL AND THE ORGANIZATION THEY
REPRESENT, IF ANY, FOR THOSE
WISHING TO PROVIDE FURTHER
COMMENTS. WE ARE ACCEPTING
WRITTEN TESTIMONY THROUGH THE
POSITION LETTER PORTAL ON THE
COMMITTEE'S WEBSITE. UH, AND
WITH THAT, WE WILL TAKE A BRIEF
RECESS. EXCUSE ME. WE HAVE A
QUORUM. WE'VE MADAM SECRETARY.
PLEASE CALL THE ROLL. BERMAN.
FLORA. COLONIES PAINS HUANG
CARILLO CHEN DIXON. GIBSON.
GRAYSON. JACKSON. HELLO.
LOWENTHAL. WIENER. QUINN.
PELLERIN. SANCHEZ. SORIA.
ZIPPER. GREAT WE HAVE A QUORUM
WITH THAT WILL BEGIN TODAY'S
HEARING WITH THE PRESENTATION OF
ASSEMBLY BUILT 1570 BY
ASSEMBLYMEMBER'S LOW NUMBER OF
LOW READY WHEN YOU ARE.
RICHARD CHAIR AND COMMITTEE
MEMBERS. THANK YOU VERY MUCH FOR
ALLOWING ME TO PRESENT THIS SOUL
BILL TODAY. I UNDERSTAND IT ON
ASSEMBLY BILL 1570, WHICH I KNOW
IS A VERY EXCITING FOR SO MANY
WHO SEE THE VISION AND CLARITY
ON THIS PROPOSED LEGISLATION.
UH, THIS IS. NOT A NEW CONCEPT
ACCESS TO CAROL, ESPECIALLY IN
RURAL CALIFORNIA HAS BEEN A
CRITICAL PROBLEM MADE WORSE BY
THE FACT THAT IT TAKES A LONG
PERIOD OF TIME TO FIND A
PRACTITIONER WHO TAKES MEDICAL
WHEN OPTOMETRISTS PROVIDE 81% OF
I CARE PROVIDED BY MEDICAL THAT
IS IMPORTANT IN TERMS OF THE
ACCESS TO CARE. IN 2022. A
SIMILAR VERSION OF THIS BILL
PASSED THIS LEGISLATIVE BODY BUT
WAS VETOED BY THE GOVERNOR.
SINCE THE VETO. MY STAFF HAS MET
WITH THE GOVERNOR'S STAFF AS
LONG AS THE RESPECTIVE BOARDS
AND OPPOSITION TO ADDRESS THEIR
CONCERNS THAT BILL PRESENTED
TODAY IS THE CONCLUSION OF THAT
OF ADDRESSING THE HOURS OF
CONVERSATIONS AND THE CONCERNS.
AS WE HAVE WENT THROUGH AS WE,
UH, TAKE HAD A CHANCE TO TAKE A
LOOK AT THE REVIEW OF THE TEST
PUBLIC TESTIMONY IN OPPOSITION.
BASED ON THE CONCERNS FROM
PREVIOUS HEARINGS. WE TOOK THE
FOLLOWING AMENDMENTS IN WHICH
WAS ADDRESSED IN THE PREVIOUS
COMMITTEE HEARINGS. NUMBER ONE
PROHIBIT CERTIFIED OPTOMETRIST
FROM PERFORMING ADVANCED
PROCEDURES ON PATIENTS UNDER THE
YEARS OF 18 YEARS OF AGE NUMBER
TWO REQUIRED THE TRAINING
PROCEDURES ON SIMULATED EYES BE
EQUIVALENT OF ENTIRE PROCEDURE.
THIS IS THE EXACT LANGUAGE THE
EXACT LANGUAGE AS REQUESTED BY
THE OPPOSITION. NUMBER THREE
REPLACE THE MINIMUM OF ONE
CORNEAL CROSS LINKING TRAINING
PROCEDURE WITH A MINIMUM OF 10.
CROSS LINKING TRAINING
PROCEDURES. THIS IS THE EXACT
NUMBER THAT OPPOSITION REQUESTED
AND PROPOSED. NUMBER FOUR
REQUIRES AT LEAST 40% OF THE
REQUIRED TRAINING PROCEDURES ON
LIFE HUMAN PATIENTS. THIS
AMENDMENT, ALONG WITH OTHERS
MAKES THIS BILL VERY SIMILAR TO
THAT OF OTHER RESIDENCY PROGRAMS
. NO OTHER PHYSICIAN. NO OTHER
PROFESSION HAS A REQUIREMENT
LIKE THIS WITH RESPECT TO THE
RENEWAL, LICENSE AND
CERTIFICATION 18 OTHER STATES
ALLOW OPTOMETRIST TO USE LASERS
18 OTHER STATES ALREADY ALLOW
FOR THESE TYPES OF PROCEDURES TO
ADDRESS THE ISSUE OF LUMPS. AND
BUMPS TO BE REMOVED. SIX OTHER
STATES CURRENTLY ALLOW FOR
OPTOMETRIST TO DO THIS PROCEDURE
AS WELL. THIS BILL REQUIRES THE
32 HOUR COURSES, OF COURSE WORK
TO ALSO BE TAKEN, WHICH WILL
ALSO REQUIRE AN INDEPENDENT,
INDEPENDENT NATIONAL EXAM. TO
OCCUR. THIS CONVERSATION ABOUT
THAT. WE DON'T WANT SUBPAR
TRAINING AS PRESENTED IN THE
BILL. NO MEMBER OF THE
LEGISLATURE WOULD WANT TO BE
ASSOCIATED WITH ANY TYPE OF
LEGISLATION THAT WOULD
POTENTIALLY HARM INDIVIDUALS.
AND AS I UNDERSTAND, WITH THE
COMMITTEE ANALYSIS AND SUPPORT
FROM THE CHAIR AS WELL, I ALSO
DON'T BELIEVE THAT THE CHAIR
WOULD ALSO LEND HIS NAME. AND
THE HARD WORK OF COMMITTEE STAFF
AND POLICY WORK IN ADDRESSING
THIS ISSUE WITHOUT MAKING SURE
THEY ARE THE SAFEGUARDS AND
PROTECTING PATIENT CARE, SO
YOU'LL HEAR A LOT OF
CONVERSATIONS FROM OPPOSITION
ABOUT LACK OF TRAINING. BUT
SPECIFICALLY, WE POINT BLANK
LOOKED AT OPPOSITION TESTIMONY
AND IN CONVERSATIONS AND ADDRESS
THAT IN THIS BILL, BUT THE
GOALPOST KEEPS MOVING TIME AND
TIME AGAIN. THIS IS ABOUT
HELPING TO ENSURE THAT INCREASED
ACCESS, MAINTAINING THE TYPE OF
EDUCATION OVER REQUIREMENTS TO
MAKING SURE THAT WE HAVE THE
ADEQUATE TRAINING. IN THAT
REGARD. I RESPECTFULLY ASK FOR A
VOTE AND HAVE OTHER WITNESSES
HERE ALSO TESTIFY IN SUPPORT. I
RESPECTFULLY ASKED WHERE I WROTE
THANK YOU. ASYLUM MEMBER
WITNESSES. PLEASE PROCEED.
MORNING MR CHAIRMAN, MEMBERS OF
THE COMMITTEE TERRY MCHALE WITH
AARON READING ASSOCIATES
REPRESENTING CALIFORNIA
OPTOMETRIC ASSOCIATION. FIRST OF
ALL, IS THERE A NEED FOR THE
BILL? CERTAINLY THERE IS A NEED.
THE GOVERNOR IS ADDING 750,000
NEW PEOPLE TO MEDICAL THIS YEAR.
OPTOMETRY TAKES 81% OF THE
MEDICAL AND THE STATE OF
CALIFORNIA. IS THERE A NEED?
THERE ARE 8000 OPTOMETRIST WHO
ARE THROUGHOUT THE STATE OF
CALIFORNIA DEALING WITH
FRONTLINE HEALTHCARE. FOR
CALIFORNIANS. THERE ARE 2000
OPHTHALMOLOGIST, MANY OF THEM
SPECIALIST, HALF OF THEM OVER
THE AGE OF 50. THERE'S AN
ABSOLUTE NEED FOR THE BILL. OUR
OPTOMETRIST CAPABLE OF DOING
EVERYTHING THAT IS IN THIS BILL.
THIS IS NOT THE FIRST TIME THIS
BILL HAS BEEN HEARD. EARLIER
COMMITTEE HEARINGS THE
CALIFORNIA ACADEMY OF
OPHTHALMOLOGY PUT IN WRITING
THAT ABSOLUTELY EVERYTHING THAT
IS IN THIS BILL OPTOMETRISTS IN
CALIFORNIA ARE CAPABLE OF DOING
THE QUESTION BECOMES THE
EDUCATIONAL COMPONENT AS A
COMPARISON. WE ARE NO LONGER IN
THE VANGUARD IN CALIFORNIA ON
ANY OF THESE 18 OTHER STATES
ALLOW THE LUMPS AND BUMPS 10.
OTHER STATES ALLOW THESE
SPECIFIC LASERS, AND THEY ALLOW
THESE TO BE DONE WITH TWO
WEEKEND COURSES, 16 HOURS ON THE
LUMPS AND BUMPS 16 HOURS ON THE
LASERS IN TERMS OF THE CORNEAL
CROSS LINKING IN THE BILL. THIS
IS DONE IN THE OFFICE. THEY
ASKED WE IN THE FIRST COMMITTEE
HEARING, WE HAD JUST ONE LIFE
PATIENT BECAUSE IT'S SUCH A
PROCEDURE THAT CAN BE DONE IN
THE OFFICE. THEY ASKED FOR 10.
WE GAVE THEM 10. IN TERMS OF THE
TRAINING ALSO JUST TO BACK UP.
THIS PARTICULAR LEGISLATURE HAS
OVER THE LAST 20 YEARS EXPANDED
THE SCOPE OF PRACTICE FOR
OPHTHALMOLOGY FOR OPTOMETRY IN
SEVERAL WAYS AND IN EVERY TIME
OF THE EXPANSION OF THAT SCOPE,
IT HAS BEEN OPPOSED BY THE
ACADEMY OF OPHTHALMOLOGY HAS
BEEN OPPOSED BY THE CALIFORNIA
MEDICAL ASSOCIATION, WHICH IS
ONE OF THE REASONS 120 YEARS AGO
. CALIFORNIA MADE SURE IT WAS
SPECIFICALLY UNDERSTOOD. THAT
THESE ARE TWO VERY DISTINCT
PROFESSIONS AND WHAT WE ARE
TALKING ABOUT. LADIES AND
GENTLEMEN ARE VERY QUALIFIED
DOCTORS. THESE OPTOMETRISTS ARE
THE BEST IN THEIR CLASS IN
COLLEGE. THEY STRUGGLE TO GET
INTO OPTOMETRIST SCHOOL. THEY
HAVE FOUR YEARS OF OPTIMA TRICK
EDUCATION FOLLOWING AND I'M
GOING TO ASK YOU TO WRAP UP.
YES, SIR. THANK YOU. EVERYTHING
IN THIS BILL WERE WILLING TO
TALK ABOUT THE EDUCATIONAL
COMPONENTS. AS THE AUTHOR SAID,
WE WENT THROUGH ALL OF THE
COMMITTEE HEARINGS LOOKED AT
WHAT THEY ASKED FOR AN
EDUCATION. WE GAVE IT TO HIM. WE
ASKED FOR AN I VOTE. MR
CHAIRMAN, MEMBERS OF THE
COMMITTEE. I'M AN OPTOMETRIST.
AND MY NAME IS DR JEFFREY GARCIA
. TODAY I'M HERE REPRESENTING
MYSELF AND NOT ANY ORGANIZATION
OR BOARD. MY COMMENTS TODAY ON
BEHALF OF THE 2 MILLION MEDICAL
PATIENTS IN MY REGION. THESE
PATIENTS HAVE BEEN GOING UNDER
SERVED FOR THE LENGTH OF MY
SERVICE IN OPTOMETRY 30 YEARS
AND IT'S NOT IMPROVED. YOU SEE,
THIS IS AN ACCESS TO CARE BILL.
AND I FEEL DEEPLY UH UM
CONCERNED ABOUT THIS, AND THAT'S
WHY I'M HERE TODAY. I OWN THREE
PRACTICES IN THE CENTRAL VALLEY
AND THE MORE CORCORAN AND
VISALIA THESE OUR FARM COMMUNITY
COMMUNITIES, MUCH LIKE
COMMUNITIES THAT YOU MAY COME
FROM. AREAS WHERE OPTIONS FOR
HEALTH CARE IS MINIMAL OPTION
FOR OPHTHALMOLOGY CARE IS EVEN
MORE MINIMAL, SO QUICK ACCESS TO
OPHTHALMOLOGY CARE IN MY REGION,
ESPECIALLY IS TERRIBLE. AND THE
COUNTIES OF KERN. HILLARY AND
KINGS AND FRESNO. MY REGION
THERE ARE TWO AND REPEAT. THERE
ARE TWO OPHTHALMOLOGY PRACTICE
IS THAT EXCEPT MEDICAL, THAT'S A
CRISIS, AND THAT HAS BEEN THE
SAME CRISIS FOR THE PAST 30
YEARS. IT HAS NOT CHANGED. IT IS
NOT IMPROVED, AND THERE'S NO
INDICATION THAT IS GOING TO GET
ANY BETTER, WITH MORE MEDICAL
PATIENTS COMING ON BOARD. AND
FRANKLY, IF YOUR OPHTHALMOLOGIST
PRACTICING THE CENTRAL VALLEY.
SO FROM MY PATIENTS, IT'S AN
HOUR DRIVE FROM LAMAR CORCORAN
TO FRESNO. IT'S AN HOUR AND A
HALF DRIVE TO BAKERSFIELD. YOU
KNOW, THIS IS JUST ISN'T THIS IS
NOT RIGHT AND MANY PATIENTS GO
WITHOUT CARE BECAUSE OF THE
LENGTH OF TIME IT TAKES TO GET
THE CARE. IT TAKES SEVERAL
MONTHS IN MANY CASES, UM AND A
LOT OF OUR PATIENTS, FRANKLY,
JUST FORGO THE TREATMENT BECAUSE
IT'S JUST NO NO LONGER AN OPTION
FOR THEM TO GET THE CARE. WE ARE
THEIR ONLY CARE. OPTOMETRISTS IN
THE CENTRAL VALLEY IN CALIFORNIA
ARE IN PRACTICALLY EVERY
COMMUNITY. YOU DON'T SEE THAT
WITH OPHTHALMOLOGISTS.
OPHTHALMOLOGISTS ARE CENTERED IN
LARGE, LARGER CITIES LIKE FRESNO
AND BAKERSFIELD. AND YET THEY
STILL DON'T TAKE MEDICAL I LIKE
THE MAJORITY OF MY OPTOMETRY
COLLEAGUES CHOOSE TO ACCEPT
MEDICAL EVEN THOUGH THE
REIMBURSEMENTS AND ARE ARE NOT
GOOD, AND IT'S CHALLENGING TO
PRACTICE THAT WAY. WE DO IT
BECAUSE WE BELIEVE IT'S OUR DUTY
AND OBLIGATION TO CARE FOR ALL
IN OUR COMMUNITY. THESE ARE OUR
FRIENDS, OUR NEIGHBORS. AND
THEY'RE NOT JUST PATIENTS. THESE
ARE PEOPLE THAT WE KNOW WE LIVE
NEXT DOOR TO THEM. WE SHOPPED
WITH THEM THEY LIVE WITH AMONGST
AMONGST US, AND WE JUST WANT TO
TAKE BETTER CARE OF THEM. AND IF
YOU COULD WRAP UP, THAT'D BE
GREAT. SURE. THANKS AND YOU
KNOW, I TREAT PROFOUND SIGHT
THREATENING CONDITIONS IN MY
PRACTICE EVERY DAY AT THREE
O'CLOCK, COMA INJURIES OR IN
BODIES. UH NIGHT WAS WE TREAT
THOSE EVERY WEEK? EVERY DAY. SO
PRACTICING? WHICH OF THESE, UM
ADDITIONAL PRESS SCOPES ARE NOT
IT'S GONNA BE CHALLENGING FOR US
BECAUSE WE ALREADY DO THEM. AND
FRANKLY, THESE ARE ROUTINE TYPES
OF PROCEDURES. THEY ARE NOT
EMERGENCY PROCEDURES AND WE ARE
VERY WELL SKILLED AND PREPARED
TO HANDLE THEM. THANK YOU VERY
MUCH. SO NOW? YES, SIR. THANK
YOU. WE'LL TURN IT OVER TO THE
WITNESSES IN OPPOSITION. UH
SIMILAR WITH WITNESSES AND
SUPPORT TO WITNESSES. UH Tð. ISH
MINUTES EACH. WE'RE TRACKING
WILL BE FAIR.
GOOD MORNING, MR CHAIR AND
MEMBERS. MY NAME IS GEORGE
STORIES WITH THE CALIFORNIA
MEDICAL ASSOCIATION. CMA IS
RESPECTFULLY IN OPPOSITION TO
THIS LEGISLATION. WE WANT TO
THANK THE AUTHOR AND SPONSOR FOR
THE ONGOING CONVERSATIONS ABOUT
THIS TIME. WE REMAIN OPPOSED TO
MAYBE 1570. THIS BILL ALLOWS
OPTOMETRIST TO PERFORM CERTAIN
SURGERIES AND LASER PROCEDURES
IN AND AROUND THE EYE AFTER THE
OPTOMETRIST HAS PERFORMED A
GIVEN NUMBER OF PROCEDURES.
OBVIOUSLY THE EYE IS ONE OF THE
BODIES MOST IMPORTANT AND MOST
FRAGILE ORGANS AND REQUIRES THE
HIGHEST DEGREE OF TRAINING FOR
PRACTITIONER WHO IS USING
SCALPELS AND LASERS TO TREAT
CONDITIONS. WE DO NOT BELIEVE
THIS BILL CONTAINS SUFFICIENT
TRAINING REQUIREMENTS THAT MEET
THE LEVEL OF SAFETY NEEDED. AT
THE HEART OF OUR OPPOSITION IS
THE UNDERSTANDING THAT GAINING
PROFICIENCY AND SURGERY AND
LASER PROCEDURES ON THE I
REQUIRE MULTIYEAR HANDS ON
RESIDENCY TRAINING PROGRAM THAT
ALLOWS THE RESIDENT EXPERIENCE
IN BOTH SPECIFIC PROCEDURES, BUT
ALSO GENERAL PROFICIENCY AND
SURGERY. WE BELIEVE THAT
OPTOMETRIST SHOULD GO THROUGH
THE SAME RIGORS OF RESIDENCY AS
A PHYSICIAN BEFORE PERFORMING
THIS TYPE OF SURGERY. THIS BILL
CONTAINS THE SAME FRAMEWORK OF A
B 20 TO 36, WHICH WAS VETOED BY
THE GOVERNOR IN 2022, AND WE
WERE EXPECTING A NEW PROPOSAL
FROM THE SPONSORS RATHER THAN
TWEAKING A B 20 TO 36. AND
DESPITE OTHER ARGUMENTS, THERE
IS NO GUARANTEE THAT THIS BILL
WOULD IMPROVE ACCESS FOR THOSE
REASONS. WE RESPECTFULLY ASKING
FOR NO VOTE. THANK YOU. AND I'M
HAPPY TO ANSWER ANY QUESTIONS AT
THE APPROPRIATE TIME. THANK YOU.
NEXT WITNESS. MR CHAIRMAN
MEMBERS, JOE LANG, REPRESENTING
THE CALIFORNIA ACADEMY OF AYE.
PHYSICIANS AND SURGEONS WITH ME
IS DR MARK MANUS DEPARTMENT
CHAIR AT UC DAVIS TRAINING
RESIDENTS IN SURGERY. I'D LIKE
TO JUST ADDRESS A COUPLE OF KEY
POINTS THAT WERE MENTIONED BY
THE SUPPORTERS OF THE BILL. AND
THEN I'LL LET DR MANUS TALKED
ABOUT WHAT WHAT REALLY IS THE
KEY ISSUE HERE, WHICH IS WHAT
WE'RE TALKING ABOUT, IS SURGICAL
COMPLICATIONS. SO WE HAVE, AS
THE SPONSORS INDICATED, BEEN
INVOLVED IN DISCUSSIONS WITH THE
OPTOMETRISTS OVER THEIR SCOPE OF
PRACTICE FOR 20 YEARS. IN THE
LAST FIVE YEARS, WE HAVE
ACTUALLY COOPERATED AND
COORDINATING WITH THEM IN THE
EXPANSIONS OF OPTIMISTIC SCOPE
THAT WE THAT WERE MENTIONED
EARLIER. WE DIDN'T OPPOSE THEM.
WE ACTUALLY WORKED WITH THEM IN
A COLLABORATIVE MANNER, AND
THOSE BILLS WERE SIGNED BY THE
GOVERNOR. WHAT YOU HAVE IN FRONT
OF YOU NOW, THOUGH, IS SORT OF
THE WHAT WE WOULD SAY IS THE
MOST IMPORTANT OF BILLS DEALING
WITH SCOPE OF PRACTICE, AND THAT
IS I SURGERY, WHETHER IT'S A
LASER SURGERY OR A SCALPEL
SURGERY. REALLY HAVE OVER THE
LAST SEVERAL YEARS, HAD VERY
DETAILED DISCUSSIONS. UH OH. WE
WERE HAVING THOSE DISCUSSIONS AS
IT'S REFERRED TO THE NUMBERS OF
TRAINING PROVISION IN THE BILL.
WE WERE HAVING THOSE DISCUSSIONS
IN A GOOD FAITH ATTEMPT TO REACH
A COMPREHENSIVE TRAINING
PROGRAM. UNFORTUNATELY WE DIDN'T
REACH THAT AGREEMENT. WHAT
THEY'VE CHOSEN TO DO. HOW HOURS
TAKE SOME OF THE NUMBERS THAT
WERE DISCUSSED. IN THOSE
DISCUSSIONS IN THOSE GOOD FAITH
DISCUSSIONS AND SAY THAT IT'S
WHAT WE ASKED FOR. WHAT WE'VE
ALWAYS ASKED FOR IS A
COMPREHENSIVE TRAINING PROGRAM.
WHAT THIS BILL DOESN'T DO IS
ADDRESS PROBABLY THE MOST KEY
ELEMENT WHEN YOU'RE TALKING
ABOUT REFORMING SURGERIES, AND
THAT IS LEARNING AND
EXPERIENCING WHAT TO DO WHEN
COMPLICATIONS ARISE. SURGICAL
COMPLICATIONS DO HAPPEN. THEY DO
OCCUR. AND IF YOU DON'T HAVE
EXPERIENCE AND HAVE TRAINING IN
THOSE COMPLICATIONS IN REAL TIME
, YOU WON'T KNOW WHAT TO DO WHEN
THOSE COMPLICATIONS OCCUR. THIS
BILL STILL DOES NOT ADDRESS THAT
ISSUE. IT'S FLAWED IN THAT
REGARD BECAUSE IT DOESN'T
PROVIDE ENOUGH TRAINING
PROCEDURES TO ASSURE THAT YOU
WILL ACTUALLY EXPERIENCE A
COMPLICATION IN YOUR TRAINING,
AND JUST JUST AS A TIME CHECK.
YOU'LL HAVE TWO MINUTES. YES.
NOW DR MANUS. I THINK WE'LL HEAR
IT'S JUST TO TALK ABOUT A COUPLE
OF COMPLICATIONS BECAUSE IT'S
TRULY IS WHAT WE'RE TALKING
ABOUT HERE. GREAT. YOU'VE GOT
TWO MINUTES, DOCTOR. THANK YOU.
GOOD MORNING AS JOE MENTIONED
I'M THE CHAIR OF THE DEPARTMENT
OF OPHTHALMOLOGY AT UC DAVIS.
I'VE BEEN TRAINING RESIDENTS IN
SURGERY FOR 43 YEARS HERE IN
SACRAMENTO. I BELIEVE THAT THIS
BILL REFLECTS CONSIDERABLE
MISUNDERSTANDING. OF. HOW
SURGICAL EXPERTISE AGAIN. WHICH
IS ACQUIRED AS A CONGLOMERATE.
OF UNDERSTANDING THE GENERAL
FIELD OF ATOMIC SURGERY AND THE
MANAGEMENT OF COMPLICATIONS.
THIS BILL PORTRAYS THESE
SURGERIES. THAT'S MINOR. I WOULD
BOTHER THAT THERE IS NO MINOR
SURGICAL PROCEDURE. AND
CERTAINLY THE LEAD PROCEDURES
AND THE LASER PROCEDURES. I
LOOKED AT HIM. THIS BILL AND I
HAVE SIGNIFICANT COMPLICATIONS,
INCLUDING GLAUCOMA, RETINAL
DETACHMENT. ALRIGHTY OF
INFECTIONS. I DO CROSS LINKING
EVERY WEEK IN MY PRACTICE. AND I
HAVE SEEN TERRIBLE
COMPLICATIONS, INCLUDING.
CORNEAL INFECTIONS AND
PERFORATIONS AND LOTS OF THE
EYE. SO THE NOTION THAT THESE
ARE MINOR PROCEDURES. IS UH, IS
FALLACIOUS QUITE FRANKLY. UM.
OPTIMA TRICK TRAINING, EVEN WITH
BASIC INSTRUCTION IN THE
MECHANICS. OF A PROCEDURE.
REALLY DOES NOT PROVIDE THE
PRACTITIONER WITH THE BROAD
ABILITY Dð. OBTAIN SURGICAL
JUDGMENT AS TO WHEN TO DO A
PROCEDURE AND HOW TO MANAGE THE
COMPLICATIONS OF THOSE
PROCEDURES. UM. NO ONE IN THIS
ROOM KNOWING THAT YOU'RE AT YOUR
DESK RIGHT? THIS DESK, INCLUDING
OPTOMETRY COLLEAGUES AND OUR
OPTIMA TRICK LOBBYISTS. I WOULD
SUBMIT TO A PROCEDURE DONE BY
SOMEONE WITH INADEQUATE SURGICAL
TRAINING. I WOULD POSIT THAT THE
BILL, AS IT'S WRITTEN, SIMPLY
DOES NOT PROVIDE UH, THE
EXPERTISE THAT IS REQUIRED FOR
ANY SURGICAL PROCEDURE. BE IT
EVEN MAJOR OR MINOR. GREAT NOTE
TO END ON. THANK YOU, DOCTOR.
NOW LET'S OPEN IT UP TO ANY
ADDITIONAL WITNESSES. WHY DON'T
WE START WITH ADDITIONAL
WITNESSES IN SUPPORT OF THE BILL
, PLEASE PROVIDE YOUR NAME
ORGANIZATION YOU'RE WITH IF ANY
IMPOSITION ON THE BILL. DR DAVID
REDMON, PRACTICING MOUNTAIN
VIEW. SUPPORT THE BILL. THANK
YOU. RONALD. RONALD CAN YOU HEAR
ME? THANK YOU. RONALD SEEGER.
PRIVATE PRACTICE OPTOMETRIST,
ALSO IN MOUNTAIN. THANK SUPPORT
THANK YOU. JOHN AND JOHN ROSTEN.
I'M IN PRACTICE IN DIXON AND I'M
IN SUPPORT OF THE BILL. THANK
YOU. MORNING MR CHAIR MEMBERS,
SARAH NECESITO ON BEHALF OF VSP
VISION HERE IN SUPPORT. THANK
YOU. I AM NICOLE MOSE, PRIVATE
PRACTICE OPTOMETRIST AND SUPPORT
OF THE BILL. THANK YOU. MY NAME
IS OUR JENSEN. HELLO MY NAME IS
OUR JAM SHIN AND, UM, PRE
OPTOMETRY STUDENT. I'M IN
SUPPORT OF THE THANK YOU. HI I'M
SPENCER FAIR GRAVE. I'M A
PRIVATE PRACTICE OPTOMETRIST,
AND I'M IN SUPPORT OF THE BILL.
THANK YOU. HI I'M TOM
FLEISCHMAN, RETIRED OPTOMETRIST.
I'M HERE IN SUPPORT OF THE BILL.
THANK YOU VERY MUCH. ANY
ADDITIONAL WITNESSES IN
OPPOSITION TO THE BILL. PLEASE
COME ON UP AND WRITE YOUR NAME
ORGANIZATION YOU'RE WITH IF ANY
IMPOSITION ON THE BILL. HIM
STONE STONE ADVOCACY ON BEHALF
OF THE CALIFORNIA ORTHOPEDIC
ASSOCIATION AND RESPECTFUL
OPPOSITION. THANK YOU. THANK
YOU. THANK YOU, MR CHAIR AND
MEMBERS DON SINCE KEY ON BEHALF
OF THE CALIFORNIA SOCIETY OF
DERMATOLOGY AND DERMATOLOGIC
SURGERY, ALSO, THE CALIFORNIA
SOCIETY OF PLASTIC SURGEONS AND
OPPOSITION THANK YOU. HELLO
DAVID BULLOCK ON BEHALF OF SAN
FERNANDO VALLEY ALLIANCE, TAKE A
STAND. SANTA'S LAW TAX LAW
TRUTH, JUSTICE LAW FIRM PER
GROUP AND FREEDOM ANGELS, ALL IN
OPPOSITION OF SECTION FIVE D
ONLY OF THIS BILL, WE HAVE NO
POSITION ON ANY OTHER PARTS OF
THIS BILL. THANK YOU. THANK YOU.
ANY ADDITIONAL WITNESSES, UH IN
SUPPORT OR OPPOSITION TO THE
BILL. SEEING NONE GONNA BRING IT
BACK TO COLLEAGUES FOR QUESTIONS
OR COMMENTS. DR JACKSON. THANK
YOU VERY MUCH, UM MR CHAIR, I
THINK, UM, JUST A FEW QUESTIONS
BECAUSE I WANT TO JUST MAKE SURE
THAT WE'RE GETTING THINGS RIGHT,
BECAUSE OBVIOUSLY THERE'S BEEN A
LOT OF NUMBERS AND A LOT OF DATA
OLD AND NEW FLOATING AROUND. AND
SO I THINK, UM, THE IMPORTANT
PART IS WHAT WILL DO THE MOST
GOOD. AND WHAT WE'LL DO. THE
LEAST HARM WHILE TRYING TO DO
THE MOST GOOD. AND SO WHAT I'M
HEARING IS THAT UM OTHER STATES
ARE ALREADY DOING THIS. IS THAT
CORRECT? NOW. IF OTHER STATES
ARE DOING SO, HAS THERE BEEN ANY
RED FLAGS? IN TERMS OF THE OTHER
STATES THAT HAVE DONE SO. AND IF
THERE ARE RED FLAGS, WHAT ARE
THEY? YES THAT'S FINE. OKAY
THANK YOU. SIMON JACKSON. UM I
GUESS I'D ANSWER THE QUESTION
TWO WAYS ONE. THERE ARE SOME
STATES THAT ALLOW FOR SOME
COMBINATION OF THE PROCEDURES
THAT ARE INVOLVED. THEY TEND TO
BE SMALL STATES, SMALLER
POPULATIONS. AND THE REALITY IS
THERE IS NO DATA COLLECTION.
THERE IS NO DATA REQUIREMENT IN
THOSE STATES. AS A RESULT, WE
HAVE NO DATA TO WORK FROM. BUT
NONE OF THE STATES PROVIDE FOR
THE COMPREHENSIVE NUMBER OF
SURGERIES. BOTH LASERS AND SCALP
, ALS AND CORNEAL CROSS LINKING
BETTER INVOLVED IN THIS BILL
OTHER THAN THE STATE OF OKLAHOMA
, SO WE JUST DON'T UNFORTUNATELY
, THERE JUST ISN'T ANY DATA AND
NOT ANY REAL WAY TO COLLECT THAT
DATA BECAUSE THEY? IN MOST CASES
, THE STATES OPERATE IN A
COMPLAINT DRIVEN SYSTEM, NOT IN
A RESULT DRIVEN SYSTEM. SO THERE
JUST ISN'T ANY DATA. MHM DOCTOR
JACKSON, UH, TERRY MCHALE. UH
HUH. TWO THINGS IN RESPONSE ONE.
IT IS ABSOLUTELY TRUE THAT THE
18 OTHER STATES AND THE 10 OTHER
STATES LASER DO NOT REQUIRE A
COMPREHENSIVE EDUCATION THAT
WE'RE REQUIRING IN THIS BILL. IN
TERMS OF ARE THERE OTHER STATES
WHERE WE CAN HAVE DATA IN 2022,
COLORADO, BECAME THE 18TH STATE
TO ALLOW IT AND WHEN THEY RAN
THIS BILL, THEY CALLED THE
OPTIMIST TRICK BOARDS OF THE
OTHER STATES TO SEE IF THERE HAD
BEEN ANY CONCERNS OR COMPLAINTS,
AND THE ANSWER WAS NO. I ALSO
WANT TO SAY THAT WHAT THIS BILL
DOES, IS IT? WE'RE VERY CAREFUL
THAT THERE WILL BE DATA
COLLECTION INHERENT IN THIS BILL
IS THAT WE MUST REPORT TO OUR
CALIFORNIA BOARD OF OPTOMETRIC
WHAT WE ARE DOING AND IF ANY
PROBLEMS ARISE SO IT CAN BE
REVISITED, BUT THERE IS DATA
THERE HAVE NOT BEEN COMPLAINTS
THOSE OTHER STATES HAVE SEEN IN
EXCESS OF ONE. 100,000 OTHER
PATIENTS WITHOUT A PROBLEM.
THANK YOU. NOW WHEN WE TALK
ABOUT, UM, MIGHT HAVE A FEW
MORE, MR CHAIR. I'M JUST LETTING
YOU KNOW NOW, UH UM WE TALKED
ABOUT THE, UM THE 10 PROCEDURES
TO BE ABLE TO GET CERTIFICATION.
IS THIS IN LINE OR LESS THAN
WHAT OTHER STATES ARE REQUIRING?
THE 10 PROCEDURES CAME. UH I
WANT TO. FIRST OF ALL SAY THAT
IT NO TIME. AS OPTOMETRY EVER
SUGGESTED. DID ANY OF THESE
PROCEDURES THAT ARE ON THIS BILL
SHOULD BE TAKEN LIGHTLY. OR THAT
ANY PATIENT? SHOULD EXPECT THAT
THE CARE THEY'RE GOING TO
RECEIVE FROM AN OPTOMETRY WILL
BE ANYTHING LESS FOR THESE
PARTICULAR PROCEDURES THAN THEY
WOULD RECEIVE FROM AN
OPHTHALMOLOGIST IN TERMS OF THE
CORNEAL CROSS LINKING WHEN WE
HAD THIS IN TESTIMONY IN THE
LAST COMMITTEE LAST YEAR THAT
WENT TO THE BILL THAT WENT TO
THE GOVERNOR. WE SAID ONE
PROCEDURE BECAUSE IT'S THE
DROPPING OF THE TIME THEY CAME
BACK AND ASKED FOR 10 HOLD ON
CONCERNED ABOUT BUT BACK AND
FORTH, BUT I'M ASKING IS THERE
IS CERTAIN AMOUNT OF PRACTICE
FOR OF PROCEDURES THAT OTHER
STATES ALSO REQUIRE. IS THAT
CORRECT? AND WHAT IS THEIR
HIGHEST NUMBER OF PROCEDURES
THAT THEY'RE REQUIRED COMPARED
TO GREAT QUESTION? ONLY
MISSISSIPPI. REQUIRES LIVE.
PATIENTS. IN ORDER TO BE
CERTIFIED. THE OTHER STATES
ALLOW YOU TO WORK ON SIMULA EYES
AND ON AND PIG EYES AND THOSE
KINDS OF THINGS AND RELY ON THE
FACT THAT THE EDUCATION YOU
RECEIVE AS AN OPTOMETRIST. UH IS
ENOUGH. THAT YOU DON'T NEED THE
LIFE PATIENTS, CALIFORNIA THIS
PARTICULAR BILL REQUIRES LIVE
PATIENTS. AND HOW IN EXCESS OF
OTHER STATES. OKAY? AND WHEN WE
TALK ABOUT, UM THE.
CERTIFICATION PROCESS WHO.
CERTIFIES THAT THEY HAVE BEEN
CERTIFIED. YEAH. GREAT QUESTION.
IF WE CAN BACK UP JUST FOR A
SECOND. I DON'T KNOW IF WE HAVE
ENOUGH TIME TO BACK UP QUICK,
BUT BECAUSE I ANSWERED THAT
QUESTION TOO FAR. YEAH BE
CAREFUL NOW. YOU KNOW,
SPRINGSTEEN SAYS ONE STEP
FORWARD. TWO STEPS BACK. COME
RIGHT BACK. UH, THE SUGGESTION
FROM THE OPPOSITION. IS THAT
THIS BILL IS IDENTICAL. OR
BARELY TWEAKED WITH WHAT WENT TO
THE GOVERNOR AND IS NOW BEING
SUGGESTED TODAY. THERE IS A
SIGNIFICANT AND PROFOUND
DIFFERENCE IN THIS BILL. DR
JACKSON. THAT SEPARATES IT FROM
WHAT WE HAD PREVIOUSLY. 40% OF
ALL OF THE LIFE PATIENTS MUST BE
DONE IN A COHORT SYSTEM. COHORT
WAS THEIR WORD. BUT OSTENSIBLY
WHAT COHORT IS ALMOST A
RESIDENCY. FOR OPTOMETRIST TO BE
ABLE TO DO THESE PROCEDURES. THE
COHORT SYSTEM REQUIRES THAT FIVE
OPTOMETRIST WORK TOGETHER. AND
EACH OF THEM ARE REQUIRED TO DO
A LIVE PATIENT ALL THE WAY
THROUGH FROM THE DAY OF
EXAMINATION TO THE DAY OF
CONCLUSION. BUT ALL OF THOSE
INDIVIDUALS WITHIN THE COHORT
MUST PARTICIPATE IN THE
TREATMENT AND THE UNDERSTANDING
OF ALL OF THOSE PATIENTS, SO
LET'S JUMP BACK SO THAT
MULTIPLIER TAKES IT FAR BEYOND.
IT IS OVERSEEN BY A SPECIAL
EDUCATOR QUALIFIED IN THESE
PROCEDURES, SO THE SCHOOLS MUST
AGREE TO IT. THE SPECIAL
EDUCATOR WHO IS LIKELY AN
OPHTHALMOLOGIST MUST AGREE TO
IT. IF THE IF THE OPTOMETRIST
OPTOMETRIC STUDENT IS NOT
QUALIFIED AFTER ALL THIS, THE
LEGISLATION SAYS YOU DON'T PASS
THEM. AND THEN THEY MUST PASS A
NATIONAL EXAMINATION. AND SO
AFTER THEY PASSED THE NATIONAL
EXAMINATION, THEY'RE CERTIFIED
RIGHT. AND SO ARE WE SAYING AND
THIS IS FOR BOTH. PRO AND CON
HERE IS THAT THEY PASSED THE
NATIONAL EXAMINATION. ARE WE
SAYING THAT THEY WE CAN, UH
SAFELY. BE ASSURED THAT THEY
HAVE BEEN PROPERLY TRAINED TO DO
THE PROCEDURE IF THEY PASSED THE
NATIONAL EXAMINATION. DR JACKSON
. I THINK THE ANSWER TO THAT IS
THE WAY THE BUILDS ESTABLISHED
THE NATIONAL EXAM OCCURS BEFORE
THE HUMAN PATIENT TRAINING. YOU
HAVE TO COMPLETE THAT NATIONAL
EXAM, WHICH DOES NOT INCLUDE
HANDS ON PERFORMANCE OF
SURGERIES IN ORDER TO BE
CERTIFIED. BUT THE TRAINING WITH
THE HUMAN PATIENTS OCCURS AFTER
YOU'VE PASSED THE EXAM.
UNFORTUNATELY IS WE'VE SAID
THERE'S JUST NOT SUFFICIENT
TRAINING HERE TO MAKE SURE THAT
IN THAT TRAINING THAT THEY'RE
GETTING THAT, IN FACT, THE
EXPERIENCE OF COMPLICATION AND
KNOW WHAT TO DO ABOUT IT IN REAL
TIME, IF THEY DO AND WHAT WOULD
YOU CONSIDER SUFFICIENT? WHAT WE
HAD SUGGESTED. DR JACKSON IS
AFTER THE GOVERNOR'S VETO. WHEN
THE ORIGINAL WHEN THE IDENTICAL
BILL THAT WAS VETOED WAS
INTRODUCED LAST YEAR, WE
SUGGESTED AND EXPECTED THAT
PEOPLE WOULD TAKE A STEP BACK
AND SAY, HOW DO WE CREATE A
DIFFERENT FRAMEWORK RATHER THAN
TALKING ABOUT SPECIFIC NUMBERS
OF PROCEDURES THAT MAKE TRAINING
SUFFICIENT. INSTEAD LOOK AT HOW
SURGEONS ARE EDUCATED. AND
CREATE A FRAMEWORK BASED ON THAT
THAT IS NOT DRIVEN BY NUMBERS
BUT DRIVEN BY COMPETENCY. NO I
TOTALLY AGREE, BUT WHAT WOULD
YOU SUGGEST WOULD BE PROPER
TRAINING. SO IF YOU LOOK AT THE
GOVERNOR'S VETO MESSAGE, I'M NOT
TALKING ABOUT FROM YOUR
PROFESSIONAL EXPERIENCE. WHAT WE
WOULD SAY, WOULD YOU CONSIDER
APPROPRIATE TRAINING IS THAT
THIS SHOULD BE NOT DRIVEN BY A
SPECIFIC MINIMUM NUMBER, BUT
INSTEAD AN EDUCATION PROCESS
THAT WOULD BE SIMILAR TO WHAT
OUR RESIDENTS EXPERIENCE TO
PERFORM THESE SAME SURGERIES. IT
COULD BE A YEAR IT COULD BE TO
DR MANUS HERE IS SOMEBODY THAT
OVERSEES ONE OF THOSE PROGRAMS.
HE DETERMINES HOW MANY
PROCEDURES PATIENTS. THAT SHOULD
BE SEEN AND TREATED PRIOR TO
SIGNING OFF ON SOMEONE'S
COMPETENCY. WHAT WOULD YOU
CONSIDER APPROPRIATE TRAINING.
WELL ONCE AGAIN, IT'S FOR ME.
IT'S VERY DIFFICULT TO PUT IT
DOWN TO NUMBERS. THAT'S A VERY
SIMPLISTIC WAY OF LOOKING AT
THIS. GAINING EXPERTISE AND ANY
SURGICAL PROCEDURE IS CONTINGENT
UPON. THE BROAD UNDERSTANDING OF
OPHTHALMIC SURGERY, AND IT'S UH
INDICATIONS AND COMPLICATIONS
AND THAT'S WHAT THIS BILL
DOESN'T ADDRESS. UH, THE YOU
KNOW THE AMERICA AND THE
ACCREDITATION SYSTEM FOR
RESIDENCIES IN OPHTHALMOLOGY.
REQUIRE EXTRA NUMBER OF CASES.
AS A MINIMUM. AH, EXPOSURE. TO A
SURGICAL PROCEDURE. BUT THAT
DOESN'T NECESSARILY IMPLY.
COMPETENCE IN THAT PROCEDURE,
RIGHT? I UNDERSTAND WHAT YOU'RE
SAYING SOME PEOPLE MIGHT GAIN
COMPETENCY BEFORE OTHERS DO,
THEY MIGHT NEED MORE OR LESS
RIGHT. I WOULD PROBABLY NEED
MORE CONSIDERING MY SKILL LEVEL.
BUT I THINK OVERALL I THINK MY
LAST. MY LAST THING IS THIS UM,
I WANT TO MAKE SURE THAT WE'RE
NEGOTIATING A GOOD FAITH. RIGHT
I THINK, AS LEGISLATORS WE
EXPECT THAT IF YOU ARE IN
SUPPORT OR IN OPPOSITION THAT
THERE'S PROPER COMMUNICATION
GAMES ARE NOT BEING PLAYED. WE
ARE GETTING BACK TO EACH OTHER
IN A TIMELY FASHION. WE'RE NOT
TRYING TO RUN OUT THE CLOCK ON
STUFF, RIGHT? ALL OF THOSE
THINGS ARE IMPORTANT AS WE DO
OUR JOB. THIS IS A TWO YEAR
BILL. WE'VE HAD A LOT OF TIME TO
TALK. AND THE ONLY REASON WHY A
SUFFICIENT AMOUNT OF TIME TO
TALK HAS INCURRED. BECAUSE
PEOPLE HAVE CHOSEN NOT TO DO SO.
FOR ONE WAY OR ANOTHER. I DON'T
KNOW. BUT I KNOW FROM MY OWN
EXPERIENCE. I WE'VE HAD A LOT OF
MONTHS. A LOT OF MONTHS DOING
STUFF. AND WE COULD HAVE WORKED
THIS OUT IN SOME SUFFICIENT WAY.
AND SO FOR ME. IF I AM NOT
FEELING LIKE WE ARE ACTUALLY TRY
TO CREATE SOME WIN WIN
SITUATIONS HERE. WHERE WE'RE
DOING THE BEST FOR OUR PEOPLE.
THAT WE'RE ADDRESSING SERVICE
GAPS. RIGHT BUT WE'RE MAKING
SURE THAT PEOPLE ARE PROPERLY
CERTIFIED, PROPERLY TRAINED TO
DO THIS, RIGHT? SO AT THIS AT
THIS TIME, UM I'LL VOTE TO MOVE
IT FORWARD, BUT I'M NOT
GUARANTEEING I'M GOING TO VOTE
ON IT ON THE FLOOR. AND YOU KNOW
I LOVE YOU, BOO. BUT AT THE END
OF THE DAY, I WANT TO SEE SOME
GOOD TALKS. SOME GOOD WORKOUTS
HERE. BUT. WHAT I'M SEEING RIGHT
NOW IS REALLY FRUSTRATING TO ME.
AND I HOPE THAT WE CAN ACTUALLY
GET TO WHERE WE NEED TO BE. SO
THAT WE CAN ACTUALLY DO RIGHT BY
THE PEOPLE WHO WERE TRYING TO
SERVE. THANK YOU, MR CHAIR.
THANK YOU, DR JACKSON. ANY
ADDITIONAL QUESTIONS? DR BAINES,
AND THEN SOME MEMBERS UBER AND
THEN IT'S TIME FOR BEGINNER. OH,
THANK YOU SO MUCH LEARNING THIS.
FIRST OF ALL, I JUST WANT TO
THANK BOTH SIDES FURTHER WORK ON
THIS OVEN. YOU KNOW, YOUR HEART
IS IN THE RIGHT PLACE, AND I
RESPECT YOU AS A COLLEAGUE. UM I
AM A RURAL DOC THAT WORKS WITH
MEDICAL PATIENTS IN DELANO,
CALIFORNIA AND HAVE A BIG
CONCERN OF ACCESS TO HEALTH
CARE. YOU KNOW WHAT I DID ON MY
BREAK? I WORKED IN MY CLINIC
BECAUSE THEY WERE GOING TO SHUT
IT DOWN BECAUSE THEY COULDN'T
FIND A PROVIDER. I WORKED
CHRISTMAS DAY I WORKED NEW
YEAR'S EVE. I WORK CHRISTMAS EVE
. I WORKED EVERY SINGLE DAY IN
MY COMMUNITY PROVIDING
HEALTHCARE BECAUSE I CARE. I
CARE ABOUT ACCESS TO HEALTH
CARE. AND I ALSO CARE ABOUT MY
PATIENTS HAVING THE HIGHEST
LEVEL OF QUALITY OF HEALTH CARE
AS WELL. UM AND I STILL HAVE A
COUPLE OF QUESTIONS REMAINING. I
WOULD LIKE TO KNOW HOW 15,000
HOURS OF AN OPHTHALMOLOGICAL
RESIDENCY IS COMPARABLE TO 10
CASES. I WOULD ALSO LIKE TO KNOW
WHY ONLY 40% OF LIFE LIKE
PATIENTS WILL BE USED FOR THESE
PROCEDURES. AT THE END OF THE
DAY. IT'S ABOUT SAFETY. IT'S
ABOUT THE 10% THE COMPLICATIONS
THAT ARISE THAT I SAW RAVAGE MY
COMMUNITY DURING COVID YOU SEE
IN THE CENTRAL VALLEY, WE HAVE
ONE OF THESE SEVERE IST LACK OF
ACCESS TO HEALTHCARE COMPARABLE
TO THE REST OF THE COUNTRY. AND
WE SAW THAT BY HOW MANY PEOPLE
DIED DURING COVID BECAUSE OF
UNDERLYING ILLNESSES BECAUSE OF
LACK OF ACCESS TO PREVENTATIVE
CARE. THAT 10% OF COMPLICATIONS
EVERYONE KEEPS TALKING ABOUT IN
MY COMMUNITY IN THE CENTRAL
VALLEY IS ACTUALLY CLOSER TO 90
TO 100. I WATCHED IT RAVAGED MY
COMMUNITY. LASTLY I'LL ALSO END
WITH THIS. I DON'T THINK
CALIFORNIA SHOULD EVER TAKE
MEDICAL ADVICE FROM STATES THAT
HAVE A TOTAL BAN ON ACCESS TO
HEALTH CARE FOR WOMEN, INCLUDING
ABORTION BANS. THANK YOU. THANK
YOU, DR BAINES. AND THANK YOU
FOR YOUR SERVICE TO YOUR
COMMUNITY. ANY ANSWERS ANY OF
THE COMMENTS. ABSOLUTELY CLOSE.
MR. HERE, GOT IT. OKAY MR. CHAIR
YOU KNOW, JUST RESPONDING JUST
TO CLARIFY, UH DR BAINES. UM.
THERE IS A VERY BIG DISTINCTION
BETWEEN TRYING TO PARSE MINIMAL
NUMBER OF TRAINING PROCEDURES
THAT GO INTO PROPER TRAINING
VERSUS AS YOU POINTED OUT THE
15,000 HOURS THAT UP TÂM OLOGY
RESIDENTS EXPERIENCE AFTER
GRADUATING FROM MEDIC NOW THAT
ALLOWS THEM TO DO COMPLICATED
SURGERIES LIKE CATARACTS. RIGHT
NOW. THE ATTACHMENTS, HOWEVER,
THOSE SAME RESIDENTS. IN THAT
15,000 OUR PROGRAM, EXPERIENCED
THESE SAME SURGERIES AND PERFORM
HUNDREDS OF THESE SAME SURGERIES
THAT ARE IN THIS BILL. THAT IS
ONLY REQUIRING 10 IN ONE CASE,
SEVEN IN ANOTHER, AND THAT'S
REALLY THE DISTINCTION HERE. CAN
YOU CAN YOU BE ASSURED THAT IN
SEVEN CASES OF A LASER THAT
YOU'RE ACTUALLY GONNA EXPERIENCE
A COMPLICATION AND KNOW WHAT TO
DO, AND WE JUST HONESTLY THINK A
DIFFERENT APPROACH, MAKING
TRAINING THE PRIORITY AS OPPOSED
TO THE MINIMAL TRAINING. IS THE
RIGHT WAY TO ACHIEVE. THANK YOU,
MR LANE. ASSEMBLYMEMBER'S ABOUR.
SO THANK YOU BOTH FOR BEING
HERE. I AM A NEW MEMBER OF THE
COMMITTEE AND ACTUALLY HAD ONLY
UH FEW HOURS AN OPPORTUNITY TO
TRY TO GET MY ARMS AROUND THIS
YESTERDAY. AND SO I WANT TO
THANK BOTH FOLKS FROM THE
OPTOMETRIST AND FROM CMA FOR
SPENDING SOME TIME WITH ME. I
DIDN'T HAVE ALL OF MY QUESTIONS
ANSWERED, AND I GOT TO SAY, UM,
WHAT I HAVE COME AWAY WITH IS
BEING VERY CONFUSED ABOUT THIS
BILL. UM I ON THE ONE HAND, I
YOU KNOW, I THINK WE HAVE TWO
GOALS. ONE IS THAT WE WANT TO
MAKE SURE THAT WE'RE MAKING SURE
THAT THE PUBLIC IS SAFE AND
PROTECTIVE AND THAT THAT IS
ABSOLUTELY REALLY THE HIGHEST
GOAL THAT WE HAVE. ON THE OTHER
HAND. WE ALSO WANT TO MAKE SURE
THAT THERE'S HEALTHCARE ACCESS
FOR EVERY CALIFORNIAN AND THERE
ARE SOME BENEFITS OF THIS BILL.
IN DOING THAT. UM I WAS NOT ABLE
TO SORT OF HAVE FOLLOW UP
DISCUSSIONS WITH CMA AFTER
MEETING WITH THE OPTOMETRIST
YESTERDAY, THE QUESTIONS THAT I
HAD FOR THEM WERE WHETHER OR NOT
WHAT ADDITIONAL KINDS OF
TRAINING THERE WOULD BE LOOKING
AT, BECAUSE WHEN I LOOK AT THE
STAFF REPORT, IT LOOKS LIKE THE
TRAINING THAT WAS ORIGINALLY
ASKED FOR BY AH, BY THE BILL
AUTHOR WAS INCLUDED IN THE BILL.
AND THE RESPONSE I'M GETTING
BACK IS THAT WE NEED A DIFFERENT
FRAMEWORK AND I DON'T KNOW I
DON'T UNDERSTAND WHAT THAT MEANS
. UM IF THAT MEANS THAT THERE
ARE SOME KINDS OF SURGERIES THAT
ARE TOO COMPLICATED TO BE
INCLUDED IN THE BILL WOULD LIKE
TO KNOW THAT AND I'D LIKE, YOU
KNOW, I WOULD HOPE THAT YOU
WOULD WORK WITH THE BILL AUTHOR
TO REFINE THE BILL TO EXCLUDE
THINGS THAT ARE MORE
COMPLICATED. I DON'T HAVE A GOOD
SENSE OF. I KNOW THERE ARE SOME
THINGS IN THE BILL. THAT I'M NOT
CONCERNED ABOUT I MEAN, I'VE HAD
SORT OF SKIN TAGS REMOVED FROM
MY EYELID AND THAT WAS DONE BY A
DERMATOLOGIST, NOT NOT AN
OPHTHALMOLOGIST. AND OBVIOUSLY,
THAT WASN'T VIEWED AS SOMETHING
THAT WAS THAT RISKY, AND I
WOULDN'T THINK THAT THAT'S ALL
THAT RISKY AND ENDED UP TIME.
INTEREST COULD DO THAT. THERE
ARE OTHER THINGS THAT I HAVE A
LOT OF HEARTBURN ABOUT, THOUGH,
BECAUSE I DON'T KNOW WHETHER OR
NOT SOME OF THE PROCEDURES ARE
VERY COMPLICATED. AND IF YOU
ACTUALLY HAD A COMPLICATION, YOU
REALLY NEED A DOCTOR PRESENT AT
THAT TIME, AND I HAVEN'T HAD THE
ABILITY TO UNDERSTAND WHETHER
THE BILL INCLUDES SOME OF THOSE
THINGS OR NOT, UM SO I YOU KNOW
WHERE I AM TODAY IS THAT UM THE
OTHER THING I WOULD SAY IS THAT
YOU KNOW, I TAKE NOTE OF THE
FACT THAT A NUMBER OF STATES OF
BUT, UH, HAVE APPROVED THESE
KINDS OF PROCEDURES, BUT I'M
NERVOUS THAT THE STATES THAT
HAVE APPROVED THESE PROCEDURES
TEND TO BE SMALL STATES THAT
DON'T HAVE A HIGH DEGREE OF
COMMITMENT TO CONSUMER
PROTECTION. UM AND THAT MAKES ME
VERY NERVOUS. IT MAKES ME VERY
NERVOUS TO NOT HAVE DATA ABOUT
WHAT THOSE STATES ARE. I THINK
UPON CALL FROM COLORADO TO SOME
STATES IS NOT ADEQUATE DATA AND
MY MIND TO UNDERSTAND THAT
EVERYTHING IS GOOD IN THOSE
STATES. UM SO I'D LIKE TO HAVE
MORE DATA. UM AND THEN I THINK
THE OTHER THING IS THERE'S SOME
ACCOUNTABILITY PROCEDURES IN THE
BILL. I TALKED TO THE CHAIR LAST
NIGHT ABOUT THEM THAT I THINK
ARE GOOD THAT THEY'RE THERE, BUT
THEY'RE REALLY NOT SPECIFIC. IT
JUST REQUIRES SOME REPORTS TO GO
TO THE BOARD OF OPTOMETRY. I
DON'T. I DON'T THINK THERE'S ANY
TIMING. THERE'S NO DETAIL. YOU
KNOW THE REPORT COULD BE 20
YEARS FROM NOW, ACCORDING TO THE
BILL WHEN I READ IT, SO I THINK
THAT AREA NEEDS TO BE TIGHTENED
UP. UM, I AM GOING TO SUPPORT
THE BILL TODAY, NOT BECAUSE I'M
COMFORTABLE WITH IT. I'M I'M NOT
. I MEAN, I REALLY FEEL LIKE I
NEED TO LEARN A LOT MORE ABOUT
THIS WHOLE AREA AND WHAT'S
INCLUDED AND WHAT'S NOT INCLUDED
. BUT I DO THINK THE AUTHOR IS
MAKING A GOOD FAITH ATTEMPT TO
TRY TO WORK THESE THINGS OUT AND
WOULD ENCOURAGE HIM TO DO THAT,
AND I WOULD HOPE THAT BOTH SIDES
WOULD CONTINUE WORKING TOGETHER.
BUT IN ORDER TO GIVE THIS BILL
AN OPPORTUNITY FOR THAT TO
HAPPEN, I INTEND TO FOLLOW THE
CHAIRS RECOMMENDATION TODAY AND
VOTE. THE BILL OUT OF THE THANK
YOU. SIMON ZABAR
ASSEMBLYMEMBER'S MAKIN ER GOOD
MORNING. UM WOW. THE AUTHOR HAS
WELL INTENTIONS. UM I REALLY
HAVE AN OPPOSITION TO THIS BILL.
WHEN I THINK ABOUT EQUITY I FEEL
LIKE THERE. WE'RE NOT GONNA HAVE
EQUITY AND HEALTH CARE. I CARE
WITH THIS BILL. WE TALKED A LOT
ABOUT OUR MEDICAL PATIENTS. WHAT
ABOUT WE KNOW THAT THE MEDICAL
PATIENTS WILL GO AND USE THIS
PROCEDURE WITH THE BILL. AND
THEN OUR OUR CONDITION. FOLKS
WILL GO GET A REAL SURGEON TO
PERFORM THEIR THEIR PROCEDURE.
AND SO I FEEL LIKE THIS IS AN
EQUITY ISSUE, AND THAT'S WHY I
OPPOSED THIS BILL, BECAUSE I
KNOW FOR A FACT THAT THIS WILL
REALLY HARM OUR POOR COMMUNITY.
AND I DON'T WANT TO SEE THAT
HAPPEN. AND SO I'M SORRY. I'LL
HAVE TO OPPOSE THIS BILL. THANK
YOU. THANK YOU. REMEMBER MAKIN
ER ASSEMBLYMEMBER'S PELLERIN.
THANK YOU. AND THANK YOU TO THE
AUTHOR FOR YOUR WORK ON THIS
BILL, AND I KNOW YOU'RE TRYING
TO DO WHAT'S BEST FOR THE STATE
OF CALIFORNIA. I JUST WANT TO
CLARIFY HOW MANY OTHER STATES
HAVE OPTIMUM OPTOMETRIST
PERFORMING ALL OF THE PROCEDURES
IN THIS BILL. 11. OKAY ALL
RIGHT. AND, UM. SO MY
UNDERSTANDING IS THAT
OPHTHALMOLOGISTS COMPLETE FOUR
YEARS OF MEDICAL SCHOOL. AND
THREE OR FOUR YEARS OF RESIDENCY
TRAINING. FURTHERMORE
OPHTHALMOLOGISTS THAT DO CORNEAL
CROSS LINKING REQUESTED
PROCEDURE IN THIS BILL. DO AN
ADDITIONAL 1 TO 2 YEARS OF
FELLOWSHIP TRAINING IN CORNEA
DISEASES AND SURGERY. AM I
CORRECT IN THAT ASSESSMENT? AND
WE'RE ASKING. I'D HATE TO PUT
PEOPLE WHO WANT TO DO GOOD AND
HELP THEIR PATIENTS OUT DOING
THESE PROCEDURES WITH JUST WOULD
YOU SAY ONE WEEKEND 16 HOURS OF
TRAINING? THAT'S ANOTHER STATE
THAT HAS WHAT IS ALLOWED AND I
WANT TO MISS. CAN I CHANGE MY
ANSWER? IT'S SIX OTHER STATES
ALLOW ALL OF THESE PROCEDURES. I
WAS MISTAKEN. THANK YOU FOR THE
CORRECTION. YEAH, BUT I'M JUST
CURIOUS. THE AMOUNT OF TRAINING
WHERE WE'RE SAYING OK, YOU UPPED
OPTOMETRIST CAN DO THIS
PROCEDURE WITH 16 HOURS OF
TRAINING. NO IF YOU SEE THE
TRAIN THAT THE PROCEDURE RIGHT
NOW WHAT THE WHAT THE PROCEDURE
IS, IT HAS THREE COMPONENTS TO
IT. THE PROCEDURE REQUIRES YOU
TO REMOVE THE PART OF THE FRONT
PART OF THE FRONT RIGHT PART TO
BREATHE THE CORNEA, AND THAT'S
SOMETHING THAT THEY'RE ALLOWED
TO DO UNDER CURRENT LAW. THEN
YOU PUT RIGHT WITH FLAVOR AND
DROPS ON THE EYE, AND THEN YOU
PUT IT ON HER OWN ULTRAVIOLET
LIGHT. YOU CAN. YOU CAN USE IT
RIGHT, BRO. FLAVOR AND DROPS AND
YOU CAN USE LIGHT. THESE ARE ALL
PERCY. ALL PARTS OF THESE
PROCEDURES YOU CAN DO UNDER
CURRENT LAW. YOU CAN'T DO THEM
TOGETHER UNDER THE WAY THAT THE
CURRENT LAW READS, AND SO THAT
IS WHY THAT WE BELIEVE THE
PROCEDURE IS NOT A BIG STEP AWAY
FROM WHAT OPTOMETRISTS DO UNDER
CURRENT LAW, ASSEMBLYWOMAN
PELLERIN SPECIFICALLY ON THE 16
HOURS. THAT'S WHAT'S ALLOWED IN
THE OTHER STATES. UNDER
ASSEMBLYMEMBER'S LOWS, BILL IT'S
GOING TO TAKE SIX MONTHS FOR AN
OPTIMUM ON AN OPTOMETRIST TO GET
CERTIFIED. THEY HAVE TO DO THE
32 HOUR COURSE THEY HAVE TO DO
THE LIVE PATIENTS AND AS THE
OPPOSITION HAS ASKED FOR AND WE
HAVE GIVEN THEM THEY WANTED A
RESIDENCY STYLE EDUCATIONAL
PROGRAM. WE GAVE THEM THE COHORT
PROGRAM THAT GETS AWAY FROM THE
NUMBERS AND TALKS MORE
SPECIFICALLY ABOUT WHAT HAPPENS
IF THERE'S COMPLICATIONS. WHAT
HAPPENS IF THERE'S IF THERE'S A
NEED FOR SURGICAL INTERVENTION.
I WOULD SAY THIS. WE BELIEVE
THAT THE OPHTHALMOLOGIST IN THE
STATE OF CALIFORNIA ARE THE BEST
IN THE WORLD. WE HAVE ABSOLUTE
RESPECT FOR THEM. WE HAVE
ABSOLUTE RESPECT FROM THE
OPPOSITION TALKS ABOUT
COMPLICATED SURGICAL PROCEDURES.
WHAT THIS BILL DOES IS ALLOW
THEM TO USE THE EDUCATION, THE
TRAINING AND THE EXPERIENCE.
THEY HAVE TO TAKE CARE OF. NOT
ONLY THOSE PEOPLE ON MEDICAL BUT
ALL INDIVIDUALS AND I WOULD JUST
CLOSE BY SAYING THIS WHEN IT
COMES TO THESE SURGICAL
PROCEDURES. THE OPTOMETRIST IN
THE STATE OF CALIFORNIA ALREADY
DO THE PRE OP AND THEY DO THE
POST OP AND THEY WORK CLOSELY
WITH OPHTHALMOLOGISTS THROUGHOUT
THE PROGRAM. YOU KNOW, I
APPRECIATE THAT AND I JUST I DO
HAVE CONCERNS ABOUT THE
DIFFERENT LEVELS OF TRAINING.
WE'RE PUTTING ON EACH PROFESSION
HERE AND I MYSELF HAVE BEEN A
PATIENT OF AN OPHTHALMOLOGIST
FOR SOME EYE SURGERY, AND
SOMETHING DID GO WRONG. AND I
WAS LUCKY THAT THIS PERSON HAD
THE TRAINING AND SKILLS TO DEAL
WITH UNFORESEEN CIRCUMSTANCE AND
WAS ABLE TO CORRECT AND GET THE
RIGHT TOOL AND DO THE RIGHT JOB
CORRECTLY. SO, UM I APPRECIATE,
UM, ARE AUTHORS IN THIS ATTEMPT
TO DO THIS BILL, BUT I'M GOING
TO BE NOT VOTING TODAY. THANK
YOU. ASSEMBLYMEMBER'S PELLERIN
ASSEMBLYMEMBER'S CARILLO. THANK
YOU, MR CHAIR. UM, FIRST I WANT.
TO ACKNOWLEDGE THAT IT IS HUMAN
NATURE TO FEAR CHANGE. IT IS
HUMAN NATURE TO FEAR THAT
SOMEBODY ELSE WANTS TO EVEN WHEN
I USE THE WAR INTRUDE INTO OUR
PROFESSION. UM AND I DISAGREE
WITH YOUR ASSESSMENT OF HOW THIS
BILL WOULD AFFECT OUR
COMMUNITIES. UM RESPECTFULLY
BECAUSE HE THE REGION THAT I
REPRESENT. THERE IS A LACK OF
ACCESS. AH IT IS RURAL AREA. UM
FOR ABOUT THREE MILES OR
WHATEVER REPRESENT AND THE
POPULATED REGIONS OUT ON THE
EDGES OF THE DISTRICT THAT I
REPRESENT. AND YOU KNOW, WE HAVE
TO DRIVE DOWN 12 A OR SOMEBODY
YOU KNOW RIVERSIDE TO BE ABLE TO
HAVE ACCESS TO MEDICAL CARE. UM
I DO BELIEVE THAT THIS WILL
ACTUALLY IMPROVE OUR COMMUNITIES
MY COMMUNITY BECAUSE IT WILL
PROVIDE ACCESS. THERE WAS
SERVICE THAT IS NOT PROVIDED. IN
MY DISTRICT. THERE'S ONLY 10
OPTOMETRIST. THAT EXCEPT MEDICAL
ZERO OF THEM OLOGISTS. NOBODY
SEES OUR PATIENTS, SO THAT MEANS
THAT MY CONSTITUENTS WILL HAVE
TO TRAVEL TO BE ABLE TO GET THAT
SERVICE AND I FEEL THAT REALLY
THE BIG ELEPHANT IN THE ROOM IS
THE MEDICAL RAID. I THINK THAT
WE SHOULD BE WORKING ON
INCREASING THE MEDICAL RATES SO
THAT WE ARE ABLE TO PROVIDE
MEDICAL CARE. THAT WE ALL
CALIFORNIA DESERVED TO HAVE. UM
THE OTHER. I HAD TWO QUESTIONS
FOR THE OPPOSITION AND THE
SUPPORT, UM MEMBERS. UM THE
OPTOMETRY STUDENTS HAVE TO TAKE
THE TRAINING FROM NOW ON. WE
HEARD FROM A STUDENT IN SUPPORT
OF THE BILL. DO YOU MEAN THAT
WOULD INDICATE THAT THE
OPTOMETRIST TRAINING WILL NOW
HAVE TO INCLUDE SOME SORT OF
TRAINING THAT WE'RE TALKING
ABOUT HERE? THE OTHER THING IS,
IF OPTOMETRY IS TO WORK FOR
TECHNOLOGISTS IN ASSISTING THEM
IN DOING THOSE PROCEDURES. UM,
IF SOMEBODY CAN ANSWER THOSE
QUESTIONS, BE GREAT. I'LL GO
FIRST. CHRISTINE SCHULTZ
REPRESENTING THE CALIFORNIA
OPTOMETRIC ASSOCIATION, YES,
THIS THIS PROCEDURES ARE
INCLUDED IN THE TRAINING THAT
OPTOMETRISTS RECEIVED CURRENTLY
IN SCHOOL. AND ADDITIONALLY, OF
COURSE, THE BILL INCLUDES
ADDITIONAL TRAINING THAT
REQUIRES A 32 HOUR COURSE.
REQUIRES TESTING NATIONAL BOARD
TESTING AND REQUIRES 52
PROCEDURES ON LIVE HUMANS TO
MAKE SURE THAT THEY'RE
COMPETENT. THESE PROCEDURES ARE,
OF COURSE, MINIMUMS. NOT THE
MAXIMUM. SO THESE PROCEED IF AN
OPTOMETRIST IS NOT COMPETENT,
THE EDUCATOR CAN REQUIRE
ADDITIONAL PROCEDURES TO MAKE
SURE THAT, UH, OPTOMETRIST IS
COMPETENT. UM THE AND ALSO THE
SECOND QUESTION THAT YOU HAD WAS
INTEREST WORK ON THE MOLOCH GIST
OFFICES. ABSOLUTELY THERE'S A
LOT OF OPTOMETRISTS THAT WORKING
OFF THEM OLOGY OFFICES.
CURRENTLY IT'S A GOOD PERCENTAGE
OF INDIVIDUALS THAT WORK IN THAT
WAY. THE AUTHOR MENTIONED THAT
THE CHAIR WOULD NOT PUT HIS NAME
ON SOMETHING THAT WOULD NOT HAVE
SAFEGUARDS AND PROTECTIONS. AND
I WOULD ALSO SAY THE SAME STEM
AND I WOULDN'T PUT MY NAME ON
SOMETHING THAT I WOULD FEEL THAT
THERE BE NO SAFEGUARDS AND
PROTECTIONS FOR PATIENTS AND
AGAIN FOR ME IN THE REGION THAT
I REPRESENT. ACCESS IS A BIG
ISSUE IN LIKE I SAID EARLIER HAD
I THINK IT'S A MEDICAL RATES
THAT WE NEED TO BE WORKING ON TO
MAKE SURE THAT ALL CALIFORNIANS
ARE ABLE TO HAVE ACCESS BECAUSE
DOCTORS OBVIOUSLY DON'T WANT TO
SEE PATIENTS ONLY FOR THE
MEDICAL RATES, WHICH ARE JUST
INADEQUATE. UM THAT'S WHAT I
HAVE TO THANK YOU. MR CHAIR FOR
ELABORATE MAKE COMMENTS. THANK
YOU ASSEMBLYMEMBER'S CARILLO ANY
ADDITIONAL QUESTIONS OR COMMENTS
FROM MEMBERS OF THE YES REMEMBER
LOWENTHAL. UM THANK YOU, MR
CHAIR. I WANT TO, UM THANK ALL
MY COLLEAGUES FOR, YOU KNOW THIS
REALLY, TRULY, UM, THOUGHTFUL
DISCUSSION. I WANT TO THANK THE
AUTHOR FOR BRINGING THIS FORWARD
IDENTIFYING A NEED. IN THE STATE
OF CALIFORNIA, AND I WANT TO
THANK DR MANUS. AND THE
OPHTHALMOLOGISTS. I REALLY
APPRECIATE THE TIME SPENT WITH
MYSELF AND MY COLLEAGUES. AT U.
C. DAVIS. EDUCATING US ON THE
PROCESS SUBSEQUENT TO THAT
MEETING, ACTUALLY I HAVE A
DAUGHTER WHO HAD ORBITAL
CELLULITIS REALLY TOUGH CASE.
AND I GAINED A TRUE APPRECIATION
FOR THE WORK THAT YOU AND YOUR
COLLEAGUES DO. I WANT TO TAKE
THIS TIME, MR CHAIR TO
UNDERSCORE THE WORDS OF MY
COLLEAGUE FROM MARINO VALLEY. AH
AND ADDRESS THE ELEPHANT IN THE
ROOM. WHICH IS THE LACK OF
COLLEGIALITY AND THE LACK OF
TRYING TO GET ANYTHING DONE
BETWEEN THESE TWO PARTIES. IT'S
NOT SERVING THE PEOPLE OF
CALIFORNIA. IT SEEMS LIKE SOME
OF THESE ISSUES CAN BE BRIDGED.
I WOULD LIKE TO ASK YOU IN FRONT
OF EVERYBODY. WOULD YOU BE
WILLING TO CONTINUE TO SIT DOWN
AND DISCUSS THESE ISSUES? IN A
PRODUCTIVE MANNER. AS WE MOVE
THIS PROCESS ALONG. YES.
ASSEMBLYMEMBER'S LOWENTHAL. YES.
OKAY. THANK YOU, MR THANK YOU.
ASSEMBLYMEMBER'S LOWENTHAL. ANY
ADDITIONAL QUESTIONS, COMMENTS
AND COLLEAGUES. SOME MEMBER
ASSEMBLYMEMBER'S. WOULD YOU LIKE
TO CLOSE? THANK YOU VERY MUCH
COLLEAGUES. FOR THOSE OF YOU WHO
HAVE NOT PREVIOUSLY SERVED ON
BNP COMMITTEE. WELCOME THIS IS
ACTUALLY ALL OF THE OTHER. THE
LICENSOR OF THE 50 PLUS ODD
LICENSE CATEGORIES. THIS IS THE
ISSUE THAT YOU WILL BE DEALING
WITH, WHICH IS HOW TO LOOK AT
THE ISSUE OF SCOPE OF PRACTICE
THAT IS OF INCREASING ASSETS
CARE TERRITORY. TURF BATTLES.
AND MANY OF US ARE NOT TRAINED
IN THIS ARENA, AND THAT'S WHY WE
HEAVILY RELY ON THE DEPARTMENT
OF CONSUMER AFFAIRS. THE BOARDS
THE INCREDIBLE DEDICATED
COMMITTEE STAFF, AS WELL AS THE
HARD WORK OF THE COMMITTEE CHAIR
TO COME UP WITH A HOLISTIC
APPROACH AND UNDERSTANDING THE
WIDE LANDSCAPE ABOUT WHAT THE
DIRECTION OF THE STATE OF
CALIFORNIA SHOULD EMBARK ON, AND
WE TAKE THIS VERY SERIOUSLY.
THIS WORK, ESPECIALLY THIS
COMMITTEE, SO I WANTED AGAIN
THANK THE CHAIR AND THE
COMMITTEE STAFF. BECAUSE THIS IS
DIFFICULT WORK AND TRYING TO
COME UP WITH A PRODUCT THAT IS
DECIPHERABLE AND DIGESTIBLE TO
EACH AND EVERYONE OF THE
LAYMAN'S TERMS ABOUT HOW DOES
THIS INCREASE ACCESS TO CARE?
HOW DOES THIS HELP SUPPORT
CONSUMER PROTECTION? AND HOW DO
WE FROM AN AUTHOR PERSPECTIVE?
WHAT IS THE LEGISLATIVE INTENT?
THEIR LEGISLATIVE INTENT IS TO
WORK WITHIN HEALTHCARE
PRACTITIONERS TO INCREASE ACCESS
TO INCREASE PATIENT CARE AND
SPECIFICALLY, HARD TO SERVE
AREAS. WHATEVER SOME BEST
PRACTICES IN OTHER STATES,
YOU'VE HEARD ABOUT IT FROM OTHER
STATES. IF THERE WERE PROBLEMS
IN OTHER STATES, WE REFER TO
THIS AS THE SUNSET PROCESS.
OTHER STATES LOOKING AT THE
REGULATORY BODY AND SAYING IF
THERE IS MALPRACTICE AND ALSO
PATIENT HARM THAT WE NEED TO
MAKE NECESSARY LEGISLATIVE
CHANGES TO INCREASE
CERTIFICATION PRACTICES OR
CERTAIN LICENSE CATEGORIES
SHOULD NOT BE ABLE TO PRACTICE
ACCORDINGLY. THAT HAS NOT COME
ABOUT FROM THE OTHER STATES.
SPECIFICALLY WE WOULD SEE DATA
FROM THAT AND WE WOULD HEAR
ABOUT THAT. AND WE WOULD
HIGHLIGHT THAT AND I WOULD NOT
LEND MY NAME TO THIS AS WELL. IN
TERMS OF THE LEGISLATIVE
APPROACH. WE HAVE COME UP WITH A
PRODUCT IN WHICH WE HAVE SAID TO
OPPOSITION. WE KNOW THAT THIS IS
A TERRITORY BATTLE FOR YOU THAT
THIS IS A TURF BATTLE. WHAT ARE
THE TYPE OF IN GOOD FAITH
EFFORTS TO LOOK AT DATA AND
CRITERIA AND ADDRESSING THESE
ISSUES? BE INCORPORATED ALL OF
THE OPPOSITION AGAIN FROM PUBLIC
TESTIMONY IN THIS REGARD, AND AS
YOU HEARD THAT THERE WAS NO
SPECIFICS, AND SO FROM A
LEGISLATIVE STANDPOINT, WHAT DO
WE NEED TO DO TO HELP ENSURE
THAT WE ARE WORKING WITH THE
OPPOSITION AND GOOD FAITH WE
HAVE DONE SO I CAN PROVIDE THE
RECEIPTS OVER A PERIOD OF TIME
AND EXHAUSTIVE CONVERSATIONS
BECAUSE I DO NOT WANT TO SIT
HERE BEFORE YOU. AND TELL YOU
SOMETHING INTO WHICH WE DID NOT
PUT THE GOOD FAITH EFFORT IN AND
WORKING WITH OPPOSITION AND
ADDRESSING THE REAL ISSUES AT
HAND. I KNOW THAT THERE ARE
THESE ARE VERY DIFFICULT ISSUES
TO SPICE OUT IN TERMS OF POLICY,
BUT FROM A LEGISLATIVE
STANDPOINT, THAT IS THE
LEGISLATIVE INTENT, AND I KNOW
THAT THIS. COMMITTEE WORKS HARD
TO ENSURE THAT WE HAVE THE
CONSUMER PROTECTION IN PLACE.
THIS IS CONTINUATION, AND I HOPE
THAT YOU WILL CONTINUE AND
HOLDING ME ACCOUNTABLE,
SUPPORTING ACCOUNTABLE AND ALSO
OPPOSITION ACCOUNTABLE TO SAY,
WHAT DOES THAT LOOK LIKE? THEN
IF THIS IS THE INTENT, HOW DO WE
GET THERE? AND WHAT WILL YOU DO
TO HELP ENSURE THAT WE ARE
PARTNERS IN THIS VERSUS JUST
SIMPLY OPPOSITION WITH THAT? I
RESPECTFULLY ASK FOR A VOTE.
THANK YOU ASSEMBLYMEMBER'S LOWER
AND I WANT TO THANK START BY
RECOGNIZING AND THINKING THE
OFFICER FOR HIS AUTHOR FOR HIS
TENACITY AND THE YEARS OF
DISCUSSIONS THAT STAKEHOLDERS
HAVE HAD ON THIS ISSUE OVER THE
YEARS. I THINK DR JACKSON
MENTIONED THIS IS A TWO YEAR
BILL. THIS IS REALLY A 10 YEAR
BILL THAT FEELS LIKE A
GENERATIONAL BILL. UH, UM AND,
UH, YOU KNOW, EVERY TIME WE HAVE
A CONVERSATION ABOUT IT, I
LEARNED I LEARNED MORE. THE
DEBATE TODAY REPRESENTS A
FUNDAMENTAL QUESTION THAT THAT
IS SOMETHING THAT THE AUTHOR,
YOU KNOW, HIGHLIGHTED AND THAT
THIS COMMITTEE IS CONSTANTLY
CONSIDERING WHICH IS HOW DO WE
BALANCE OUR NEED TO INCREASE
ACCESS TO CARE WITH THE NEED TO
PROTECT THE HEALTH OF PATIENTS,
AND I APPRECIATE THAT. THERE'S
NEVER AN EASY ANSWER TO THIS
QUESTION AND APPRECIATE THE
THOUGHTFULNESS. THAT MEMBERS OF
THE COMMITTEE HAVE SHOWN ON THIS
BILL, AND I REALLY THINK WHAT
THIS HEARING DID WAS ONE BILL,
BUT I THINK IT REALLY SENT A
NOTICE. UH TO EVERY COLLEAGUE,
THE ALL OF OUR STAFFS TO ALL THE
LOBBYISTS AND THE ADVOCATES THAT
THIS IS GONNA BE A TOUGH
COMMITTEE AND YOU GOTTA KNOW
YOUR STUFF AND YOU GOT TO REACH
OUT TO COMMITTEE MEMBERS AHEAD
OF TIME. YOU GOTTA ASK THEM THE
QUESTIONS BECAUSE COMMITTEE
MEMBERS ARE READING THESE BILLS
VERY CAREFULLY AND ARE COMING UP
WITH LONG LISTS OF QUESTIONS AND
CONCERNS THAT THEY HAVE, AND I'M
EXCITED FOR THAT. THAT'S GOING
TO PUSH ME AS A CHAIR AS WELL
THIS YEAR, WHICH WHICH IS GOING
TO BE A FUN, FUN OPPORTUNITY FOR
PURPOSES OF TODAY. I BELIEVE THE
BILL IS, UM AS AMENDED. MAKE
SIGNIFICANT PROGRESS IN ADDING
SAFEGUARDS TO THE BILL, WHILE
PRESERVING ITS INTENT WITH THAT
I'LL BE SUPPORTING THE BILL
TODAY, BUT I DO ENCOURAGE THE
AUTHOR TO CONTINUE WORKING WITH
OPPOSITION STAKEHOLDERS TO MAKE
SURE THAT ANY BILL THAT REACHES
THE GOVERNOR'S DESK STRIKES THE
BEST BALANCE POSSIBLE AND I
APPRECIATE A LOT OF THE CONCERNS
THAT WERE RAISED BY COLLEAGUES
TODAY AND I'M SURE THE BILL WILL
CONTINUE TO EVOLVE AS IT MOVES
FORWARD. SO WITH THAT I'M HAPPY
TO SUPPORT THE BILL. MADAM
SECRETARY. PLEASE CALL THE VOTE.
WE NEED A MOTION AND A 2ND 1ST
THANK YOU FOR REMINDING ME HOW
THIS WORKS. GOT EMOTIONAL
DILEMMA, OR CARILLO GOT A SECOND
FROM THE NUMBER OF NGUYEN. ON A
B 1570 LOW. THE MOTION IS DUE
PASS TO THE COMMITTEE ON
APPROPRIATIONS. BERMAN BERMAN I
FLORA. FLORA, IOWA KNEES.
SPAIN'S PAINS. NO ONE CARILLO
CARILLO, I CHEN CHENNAI. DICKSON
DICKSON. NO, GIBSON. GRAYSON
GRAYSON, I JACKSON JACKSON. I LO
I LO I LO AND TALL AND THOUGHT
I'M MAKIN ER MAKIN OR KNOW WHAT?
WHEN I PELLERIN HELLO AND NOT
VOTING. SANCHEZ. SANCHEZ, NOT
VOTING, SORIA. SORRY I'M NOT
VOTING IS BIRTH. I. THAT BILL IS
OUT, WE'LL LEAVE THE ROLE OPEN
FOR ABSENT MEMBERS. 10 TO 3.
THANK YOU, EVERYBODY. THE
HEARING IS NOT YET ADJOURNED.
BUT FOR YOUR INTENTS AND
PURPOSES IT IS.
EVERYBODY.
UM MADAM SECRETARY. PLEASE RUN
THROUGH THE ROLE. E B 1570 LOW,
THE MOTION IS DUE PASS TO THE
COMMITTEE AND APPROPRIATIONS
GIBSON GIBSON, I THANK YOU.
BREAD AND WITH THAT THE HEARING
IS ADJOURNED.